The room is small, it has been pigeonholed in to a wedge-shaped space. At its widest, it is about 7ft long and 3ft across but it gets smaller along its length, and that’s where the chairs are. I sit down and the door closes, cementing the irregularity of this suffocating little space we are crammed in to. A misjudged crossing of my legs could easily lead me to kick the person across from me in the shin. I don’t do this.
‘Tell me right now what is going on.’
The words ‘right now’ are spoken through teeth that are closed. I have never met this person, I don’t even know his first name or what relation he is, to my patient. He is also not the only relative in the room.
So, I introduce myself and ask if I could just find out who everyone is. Another person in the group volunteers this information, but the one who is most angry interjects again and says he is losing his patience. ‘Right now,’ he tells me. His face is red.
I look him in the eye and say in one go: ‘Sorry your wife is probably going to die, or maybe not, it’s not really clear but we have her on this machine that helps some people in some situations but not always, actually it isn’t used all that often to be honest and even less in combination with your wife’s specific problems, but I thought I’d let you know anyway because she’s definitely more critically ill then she was yesterday.’
I didn’t actually do that.
Perhaps I could have, if I had something definitive to say, something binary. But, I don’t really think you can successfully impart the intricacies of honest uncertainty amidst those sorts of hostile constraints.
I look down the line at the other two relatives and try to figure out what it is that would be ‘best’ for all of them. And I thought about myself (perhaps I’m not supposed to say that, but it is the truth). I think about the situation I wanted to walk away from, the record I want to sign my name to in the notes.
Then, I do look him straight in the eye and say: ‘I can hardly imagine what you are feeling right now, but I asked you here because I have a job to do, and I promise you that I am not going to beat about the bush, but there is a right and wrong way to do this and I am not sure you will forgive me, if I do it the wrong way.
‘You and I, we are on the same side.’
I have never said this before.
It seems to work and I’m not sure it reflects favourably on me to use the word ‘work’ there, because it highlights that the goal was to control him, for my sake as much as anybody else’s. So that I could conduct what I thought was a more successful conversation. My idea of successful.
But, it is said and we did leave the room on friendly terms.
A few hours later, he hugged me at the bedside.
By the Secret Doctor
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You should have omitted what you did not say and then you have not said much at all. So am not quite certain how you earned the hug.
Great example of the relational efficacy of honesty and vulnerability ( which also = courage, here). As opposed to defensiveness. It´s OK not to know how to do things. Less OK to protect our embarrassment by posturing and pretending or holding distressed people at arm´s length. This doctor put professional ethics - honesty and empathy - ahead of "looking good." We´re in medicine to do good, not to look good.
Mr Miss or Mrs Anonymous
your comments are out of place. Words only make up a small percentage. The secret doctor's body language obviously conveyed what was necessary in the situation.
It is really galling to hear people pontificate about a situation when they are not in it.
Well done, secret doctor. te fact you got a hug shows that you did the right thing.
The analogy is dementia care in nursing home. Here the only foreseeable outcome is progressive deterioration. In reall good nursing homes(and there are some good ones, still) relatives and carers are on the same side. Both parties want to optimise the quality of visiting as well as the quality of care despite the progressive physical and mental decline that is being spelt out before their very eyes. Long may that ethos of shared objectives prevail.
Bravo! Very sensitive, intuitive, insightful, experienced.
:-) well done
excellent. well delivered.entirely appropriate. I applaud you.
A wonderfully disarming reply. Well put!
"Anger" in a situation to hear a bad news is akin to "crying". The doctor, in this case, gave the real news which appeared as if it was a bad news. Culturally, a person from the Western Culture will restrain the action of crying as much as one can, stiff upper lip, and this would show what may appear an anger because a sad emotion has to overflow.
Whereas in the Eastern culture a relative would cry loudly; other relatives would also join in crying; in this way catharsis is achieved. They would show great respect to the doctor.
The hug of the relative to the doctor, was a Western custom; it means the relative cried on the doctor's shoulder. In Eastern culture, a doctor would give a handkerchief to the relative to dry the tears.
In olden days, I observed that doctors did tell the bad news to a relative but not to a patient, in good faith. Now the doctors tell the truth to both but tactfully, as this doctor did.
There is a hidden corner; in olden days a doctor was invited to attend the funeral. Now-a -days, if a patient dies, some relatives blame the doctor and go to a solicitor, GMC and High Court. The wind is becoming a hurricane. Please tell the truth to the patient as well as the relative and make notes on computer who said what. "Patient notes" are the property of the NHS which are provided in full to High Court or Tribunal if a judge or an authority were to make an order. Whatever you do please be careful not become a second casualty. Please change with the change to survive and thrive.
Dr Bashir Qureshi; Author of Transcultural Medicine; dealing with patients from different cultures, religions and ethnicity. Also an Expert Witness.
My Dad Died in 1987 when i was 24 years old. He had lung cancer.I knew he was very very ill.I was devastated. I got married in 1986 My Dad gave me away. I knew he would not make it.In May 1987 A Doctor came to see my Dad and said and i quote "Your Dad is dying get used to it" I was horrified. I loved my Dad and the Doctor was cruel and uncaring.I would sincerely hope times have changed and Doctors have learnt compassion
You exemplified what I teach my medical students in communication skills teaching- find the common ground, and respond with humanity. In doing both these things, and responding with directness coupled with sensitivity, you diffused a difficult situation. You definitely earned that hug.
Nevertheless the red faced angry man/member of public is becoming more and more commonplace and they often border on physical, or at very the least verbal, threatening behaviour which is unacceptable and the result of years of NHS bashing in the right wing press
I agree that you did well in the circumstances in identifying the relative who was needing an alternative direct approach. You managed to deflect his anger by taking control and finding a way to offer support and give honesty without avoiding the issues. Communication skills are something that you can never give a one stop answer and you often have to delve deep into your toolbox and improvise, a difficult art!